Plummeting patient admissions at Broward General Medical Center, a high number of patients who cannot pay, and a rift between doctors and hospital administrators have left the North Broward Hospital District struggling to avert financial disaster.

In one month alone, Broward General -- the most troubled of the district`s four hospitals -- lost $1.3 million.

District officials are responding by slashing expenses, raising hospital rates and attempting to lure more doctors to the four hospitals.

They also are considering raising taxes to the maximum allowed by the state for the first time in the district`s 38-year history. A public hearing on the proposed tax increase is scheduled for Wednesday at North Broward Medical Center in Pompano Beach.

But just raising taxes is not the answer, officials say.

``When we have to raise taxes, it`s bad enough,`` said Dr. Ivan Lavernia, the only physician on the district`s seven-member board. ``(But) we have to cut the costs and trim the budget. You cannot do business as usual because times have changed.``

The district, which oversees Broward General, North Broward, Imperial Point and Coral Springs medical centers, has stayed in the black as a whole.

But profits, which help finance new equipment purchases and improvements at the hospitals, are shrinking. The district estimates it made $15.1 million in the fiscal year that ended in July. This year, it expects to earn only $11 million.

``The fact that taxes are going to go up because revenue has dropped -- there`s obviously something wrong,`` said Dr. David Droller, who serves on Broward General`s advisory council of doctors.

District officials expect tax revenues to fall $7 million short of the cost of indigent care this budget year. The remainder of the money will have to be made up by fees charged to patients who do pay.

But a rift between hospital officials and doctors at Broward General apparently has caused a decrease in patient admissions.

On top of raising taxes to the maximum now allowed by the state, district officials hope to further ease the financial crisis by asking the Legislature to raise the district`s tax ceiling -- from the current $2.50 to $3.50 per $1,000 of taxable property value. Tax revenues provide 16 percent of the district`s $290 million budget.

Meanwhile, expenses are being cut. In May, the district board imposed an indefinite moratorium on all non-emergency purchases.

Officials said the cuts have helped the financial situation without hurting the quality of care at the hospitals.

``You have to have priorities,`` board member Lavernia said. ``I don`t think patient care will suffer.``

Still, many new expenses are beyond a hospital`s control, said Bill Bell, general counsel for the Florida Hospital Association.

``The nursing shortage is driving costs up, as are new requirements for disposing biohazardous wastes,`` he said.

Some of the problems are not unique to Broward County.

The district`s hospitals, like others around the country, are still reeling from changes in the federal Medicare system that has limited reimbursements for patient care.

Also, public hospitals, which take patients regardless of ability to pay, are being drained by costly AIDS cases and treatment of cocaine babies.

Hospital officials thought they had an answer when the Cleveland Clinic offered to perform heart surgery at Broward General, which could have helped provide much-needed revenue.

Broward General doctors opposed the move, saying the district had not adequately consulted its own doctors. When district board members approved the Cleveland Clinic plan in January, the doctors responded with an unofficial boycott of Broward General.

In February, patient admissions at the hospital fell by 330 from those in January, which resulted in a $1.3 million loss. The drop represents a 15 percent decrease in admissions from the previous February.

In later months, admissions at Broward General remained 10 percent to 15 percent less than the same period the previous year. By July, the number of patients admitted began creeping back up.

That was the same month patient rates were increased -- 18 percent at Coral Springs, 14 percent at Imperial Point, 7 percent at Broward General and 5 percent at North Broward.

Even with the increases, the hospitals remain among the least expensive in Broward.

Still, almost one-third of patient bills have gone unpaid in the district in recent years.

In comparison, about 21 percent of bills were unpaid at Memorial Hospital in Hollywood, the South Broward Hospital District`s tax-assisted hospital.

The North Broward Hospital District appears to be keeping afloat with the help of Coral Springs Medical Center, which opened in 1987 and is exceeding admissions and emergency room use predictions.

Only 18 percent of the patient bills were unpaid at Coral Springs Medical Center in the year ending July 1, compared with 36 percent at Broward General.